MEDICARE: CHARLOTTE ROSALIND SPEAR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0072714	CO

General Provider Information

NPI Number	:	1578022455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE ROSALIND SPEAR

Provider Business Mailing Address
First Line	:	23 HAMILTON ST APT B
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-3008
Country	:	US
Telephone Number	:	802-777-0886
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 HAMILTON ST APT B
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-3008
Country	:	US
Telephone Number	:	802-777-0886
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	04/10/2026

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Directions to “ CHARLOTTE ROSALIND SPEAR ” Practice Location

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